Discussing Dizzy Spells
VERTIGO AND DIZZINESS: I am sure that some percentage of
readers of this article would have had one or more attacks of vertigo
(spinning) at some stage in their lives. It is on record that 40 percent
of Americans do suffer from benign paroxysmal positional vertigo (BPPV).
These attacks involve brief episodes of intense dizziness when you
change the position of your head. Your surroundings appear to be moving
either vertically or horizontally.
This invariably occurs whilst turning your neck in bed, and rarely
whilst standing completely still, walking or in the sitting position.
Some people feel that they are actually spinning. The effect may be
slight and only just noticeable, or it may be so severe that you fall to
The condition is more common among the older people, mostly men than
in women. Everyday activities like turning in bed, looking up or bending
forward, especially if performed quickly, will trigger vertigo, often
nausea and occasionally vomiting.
BPPV can come in bouts lasting several days to many months. It may
resolve for no apparent reason only to return again at some time in the
The condition does not respond to medication like Serc, Stugeron and
stemetil, though they may give relief from nausea and general malaise.
These medications themselves can have side effects and driving a car or
working on machinery is harmful.
Vertigo is more severe than dizziness, which is often experienced as
a feeling of light-headedness when you stand up.
Mild vertigo is very common and symptoms are not serious. It is not a
disease. However, recurrent or persistent vertigo could be caused by an
underlying condition. You should see your GP to rule out a more serious
cause and to get treatment.
This problem results from a problem with the nerves and structures of
balance mechanism in your inner ear (vestibular labrynth).
It occurs when calcium carbonate particles normally contained in a
sac called utricle gets lose and fall into the wrong part of the three
canals of the inner ear, producing an episode of dizziness.
As these crystals move about inside the inner ear, they distort the
information generated by this system to the brain. The result is a
disruptive dizzy sensation of short duration.
These three canals positioned in different directions, are called
Semicircular canals because of its shape. They communicate with the
vestibule, which is a part of the vestibular labrynth.
Fortunately there is a simple way to treat this condition by self to
relieve the symptoms, such as spinning and dizziness.
The crystals, which cause the distorted information, are relocated
within the system to a section (utricle) where they do not move and
therefore no longer cause the disturbance for a while. The manoeuvre is
called the canalith repositioning procedure.
The doctor, or the physiotherapist, in the office, demonstrates this.
This procedure consists of several simple head manoeuvres.
As mentioned the goal is to move particles from the fluid filled
semicircular chambers of your inner ear into tiny bag-like structure
(utricle) where these particles don't cause trouble or will be
reabsorbed by fluids of your body. Each manoeuvre is held for about 30
Canalith repositioning procedure
(Courtesy: Mayo Foundation for Medical Education and Research)
First, you move from a sitting to a reclining position. Your doctor
will help extend your head over the edge of the table at a 45-degree
Next, with your head still extended over the edge of the table, your
doctor will prompt you to turn your head to the right about 90 degrees.
Next you roll onto your side. Your head should be slightly angled
while you look down at the floor.
Finally, you return carefully to a sitting position and then tilt
your head down. After the procedure, you must keep your head upright for
48 hours, even as you sleep. This allows time for the particles floating
in your vestibular labrynth to settle into your utricle or be reabsorbed
by your body fluids.
You may need to wear a neck collar to prevent tilting your head. It
may be necessary to repeat the procedure several times.
These manoeuvres may bring about sensation of vertigo, and
discomfort, but should not cause pain.
The next 48 hours is crucial. Keep the head upright most of the time.
Continue to be cautious and try not to perform the activities, which
cause the vertigo. When reclining, keep the trouble ear on top. (When
you turn your head during above manoeuvres you will notice that the
vertigo triggers only when moving to the side of the trouble ear.)
Use several pillows. Do not lie flat. Move slowly and not into
positions which normally cause vertigo. Again, this is necessary for two
days; this allows gravity to pull the particles away from the problem
The following self-help techniques may relieve or prevent the
symptoms of vertigo:
* Sleep with your head slightly elevated on two or more pillows.
* In the morning, get up slowly and sit on the edge of the bed for a
minute before standing.
* Avoid bending down to pick up items.
* Avoid extending your neck, for example, while reaching up to a high
* Move your head gently and slowly when at the dentist, hairdresser,
or during activities where your head is lying flat (horizontal) or the
neck is extended.
Avoid foods containing high sugar or salt content. Foods with complex
carbohydrates with lower glycaemic index, such as legumes and whole
grains are better choices.
Drink adequate amounts of fluid daily. Avoid foods and beverages with
caffeine. Limit your alcohol consumption.
Avoid aspirin and non-steroid anti-inflammatory drugs such as brufen,
When you suffer from BPPV you must see your doctor first. He will do
certain investigations to rule out other conditions that cause vertigo.
Correct assessment and diagnosis are most important.
The treatment is not difficult but it should be demonstrated and
taught by a trained medical professional, as it must be done properly in
order to be effective.
Ref: Brochure on BPPV prepared by Kathee De Lapp, St. Vincents
Hospital, Sydney www.nim.nih.gov/medlineplus
Sri Lanka now owns comprehensive data base on adolescent smoking
SMOKING HABITS: Tobacco use is one of the major preventable
causes of premature death and diseases in the world.
The World Health Organisation (WHO) attributes over 5 million deaths
a year to tobacco use, a figure which is expected to rise to 10 million
deaths a year by 2030. Seventy per cent of these deaths will occur in
Globally, one person dies every 6.5 seconds of a tobacco related
disease and tobacco consumption is on the increase. Given the current
pattern of tobacco use globally, it is estimated that 250 million
children and adolescents who are alive today will die prematurely
because of tobacco, most of them in developing countries.
In our neighbouring country, India, tobacco is estimated to cause
800,000 deaths annually.
A large body of researches in the developing world shows that most of
the adults who use tobacco at present have initiated their smoking
habits at their teens.
A large volume of researches are available in USA which shows that
nearly nine out of ten current adult smokers (89 per cent) started their
smoking habits before they reach 19 years of age.
Even limited research findings available in developing world on the
subject show, that the initiation of tobacco related products is
occurred before the smokers reach 18 years of age.
If this pattern continues in the developing countries, tobacco use
will result in the death of 250 million people who are children and
adolescents living today.
As far as the developing countries are concerned, until recent times,
a lack of research findings created a greater barrier in estimating the
magnitude of the problem of adolescent tobacco use.
Even the limited research information available in the field did not
provide a sufficient ground to make comparisons with the information
available in the developed world, due to the fact that the researchers
have followed different methodologies in conducting their researches.
In order to combat the rapid spread of the tobacco epidemic among
adolescent age children and to help countries all over the world to plan
and implement policies and programmes to control youth tobacco use, the
Tobacco Free Initiative of WHO in collaboration with the Office on
Smoking and Health (OSH), Centres for Disease Control (CDC) USA,
developed the GYTS.
The GYTS uses a common methodology, core questionnaire, and
consistent data processing for all countries. GYTS is a school based
survey conducted among students studying in grades corresponding to ages
In Sri Lanka, this included Grades 8-10 in Government and private
schools. The GYTS has been conducted in 139 countries and has been
repeated at least once in 31 countries across all six WHO regions.
GYTS includes data on prevalence of cigarettes and other tobacco use,
perception and attitudes concerning tobacco use as well as information
on access, availability and price, exposure to environment tobacco smoke
(ETS), school curriculum, media and advertising and cessation.
Data from the GYTS can be used to help countries develop, implement
and evaluate comprehensive tobacco control programmes.
Sri Lanka was privileged to have its opportunity to become one of the
seven original countries which conducted the GYTS in 1999 along with
Barbados, China, Costa Rica, Jordan, Russia, Venezuela. A repeat survey
was done in 2003.
Sri Lankan GYTS were school based surveys of students attending
grades 8-10 corresponding to the age group 13 to 15, using a
Both surveys were conducted with an anonymous, self-administered
close ended questionnaire. The questionnaire had 55 core questions and
was pilot tested before it was administered in 1999; the same
questionnaire was used in 2003.
In 1999 as well as in 2003, a two stage cluster sample design was
used to produce representative data for the entire country.
At the first stage, schools were selected with probability
proportional to enrolment size. At the second stage, classes were
randomly selected and all students in selected classes were eligible to
In 1999, the school response rate was 85.7 per cent, the student
response rate was 89.0 per cent and the overall response rate was 76.4
per cent (school - student). A total of 2,896 students participated in
the 1999 survey.
In 2003, the school response rate was 100 per cent, the student
response rate was 79.1 per cent and the overall response rate was 79.1
per cent. For the 2003 survey, 1,845 students participated.
The GYTS was administered during one class period, i.e. second period
of the day, and the procedures were designed to protect student privacy
by assuring that their participation was anonymous and voluntary.
Before the surveys were administered concurrence of the education
authorities, directorate, school heads and the parents of participating
students was obtained.
Acne - In and out
Continued from last week
What are the different types of acne?
These patients present with multiple comedones. This is due to
exposure to certain toxics, chlorinated hydrocarbons etc.
This type of acne is seen in females, especially those who had acne
in their adolescence and have used cosmetics for a long time. Sometimes
when you start using a newer cosmetic which is comedogenic, you will
notice a flare up acne.
Greasy preparations used to defreeze curly hair can cause acne
specially comedones around the forehead.
This type of acne occurs at the site of physical trauma. eg. At the
chin of violin players, due to the friction of head bands, tight bra
If you have acne together with excessive hair on your face.
In this context, you should consult a doctor, especially if you are
abnormally fat or have menstrual irregularities, because you may be
having an underlying endocrine disorder. There are certain diseases that
can mimic acne. eg. Rosacea. Your doctor will be able to differentiate
Why you should take acne seriously and seek treatment early?
Because it is no longer a common natural thing that can occur to most
of us during our adolescence. It is a disease that can end up in
permanent disfigurement due to pigmentation, scarring and keloid
If you seek treatment early, the disease can be cured and prevent
complications. So you should not hesitate to go to a doctor for
treatment early because there are number of treatment modalities
available for acne now.
Some myths about acne Acne is infectious
Some people believe that by kissing a person who has acne, sharing
the same towel can cause acne. This is not true. Although acne is cause
by a bacteria it is not infectious.
Eating oily foods can cause acne Increased sebum or oil secretion by
sebaceous glands cause acne. But oily foods only increase your blood
lipid levels and these lipids do not pass into the sebaceous glands. So
oily foods cannot cause acne. Acne patients needs to wash to their skin
thoroughly and frequently.
Many people believe that acne is related to poor hygiene. So they
wash their face excessively and frequently.
But there is no evidence that lack of washing is associated with acne
or frequent washing improves the condition. But of course if you wear
make up, it is important to wash them off as soon as possible.
How do you manage acne?
Management of acne depends on your age, sex, type of acne and its
Diet: As I have mentioned earlier eat anything in moderate amounts is
the best advice one can give.
Patients should cleanse their acne skin areas twice daily with
medicated antiacne soap. Avoid rough clothes and other scrubbing
materials. Acne patients should cleanse their skin gently. Moisturizers
can be useful for people with dry skin.
In addition, acne patients should use noncomedogenic skin care
products and cosmetics.
In general lotions and oilbased products are more comedogenic than
gel based products.